AANP Review Exam 400 Questions with Answers ,100% CORRECT

AANP Review Exam 400 Questions with Answers What are asthma triggers? - CORRECT ANSWER Smoking, dirty/dusty house, odors/sprays, furred or feathered pets, cover nose w/scarf on cold windy days, and avoid pollen/mold. Will you have a decreased PFT in welder's lung or pneumoconiosis? - CORRECT ANSWER No What is the treatment for acute bronchitis? - CORRECT ANSWER Supportive treatment (OTC pain meds, antitussives, mucolytics, hydration, expectorants, humidifier) Do you need to taper the dose of prednisone if only given 3-5 days? - CORRECT ANSWER No What is the first line treatment for chronic bronchitis? - CORRECT ANSWER SABA and inhaled anticholinergic What is the gold standard for diagnosing tuberculosis? - CORRECT ANSWER Sputum cultures What is the first line treatment for COPD? - CORRECT ANSWER SABA (albuterol) or inhaled anticholinergic (ipratropium) uncontrolled COPD- LABA with anticholinergic If you have a patient complaining of allergic rhinitis and uses Afrin nasal spray more than 3 days in a week, what can they develop? - CORRECT ANSWER Metacamentosa (rebound stuffiness) How will the patient's nasal passages present if they have a diagnosis of allergic rhinitis? - CORRECT ANSWER Blue and boggy You have a mail carrier that presents with flu like symptoms and has delivered mail today. Symptoms presented suddenly. What are we concerned about? - CORRECT ANSWER Anthrax What is the treatment for anthrax? - CORRECT ANSWER Cipro 500mg for 60 days What is the bacteria that causes atypical pneumonias (young healthy population)? - CORRECT ANSWER Mycoplasma (walking pneumonia) Signs and symptoms of atypical pneumonia - CORRECT ANSWER Fever, headache, productive or nonproductive cough What is the appropriate induration on a Mantoux test that is considered positive and in what population? - CORRECT ANSWER 5mm immunocompromised, 10mm in healthcare workers and immigrants, 15mm in everyone else If you have a nursing home patient who shares a room with someone who has confirmed TB, what duration should he be? - CORRECT ANSWER 5mm (elderly and recent exposure) What do we consider a positive reading for the Mantoux test? - CORRECT ANSWER With no induration the test is negative If a toddler comes in with a severe persistent cough, vomiting with cough, afebrile for 2-3 months, what should be ruled out? - CORRECT ANSWER Pertussis If a patient is having recurrent asthma exacerbations, what could we add to their regimen? Currently taking inhaled corticosteroid and LABA? - CORRECT ANSWER PO steroid would be appropriate • What is the severity of the asthma if using an inhaler every day and FEV1 60-80%? - CORRECT ANSWER Moderate persistent; PRN SABA and low or medium dose ICS • FEV1 60% and symptoms last all day, what is the severity? - CORRECT ANSWER Severe persistent; high dose ICS, LABA, oral steroid daily, SABA PRN • Every asthma patient regardless of severity receives what medication? - CORRECT ANSWER SABA What is used for long term asthma control? - CORRECT ANSWER LABA • FEV1 80% and symptoms are 1-2 days per week, what is the severity? - CORRECT ANSWER Mild intermittent; controlled on SABA • What is the treatment and education for a patient with exercise induced asthma? - CORRECT ANSWER 2 puffs of SABA 10-15 minutes prior to exercise; Treatment will last 4 hours • If a patient is waking every night with asthma symptoms, currently taking SABA, LABA, med. Dose ICS, what should be done at this point? - CORRECT ANSWER Refer to pulmonology • Patient complains of sleeping on three pillows to be able to breath, SOB and cough at night, gained 5 pounds in 1 week, what could be causing symptoms? - CORRECT ANSWER Worsening CHF; left sided heart failure L= lung • What are the symptoms of right sided heart failure? - CORRECT ANSWER Peripheral edema and JVD • What are we concerned with in patients with left sided heart failure taking NSAIDs? - CORRECT ANSWER NSAIDs will exacerbate CHF symptoms, NO NSAIDs • If a patient has emphysema or asthma or COPD, what cardiac medication should be avoided? - CORRECT ANSWER Beta blocker; can cause bronchospasms Which can cause an increase in respirations? - CORRECT ANSWER Hypercapnia; too much carbon dioxide in the blood • What will TB look like on a CXR? - CORRECT ANSWER Upper lobes bilaterally and look like black holes or scars • What type of cancer causes the most deaths in both men and women? - CORRECT ANSWER Lung cancer is the most common in men and women, causes the most mortality • What is the most diagnosed or prominent cancer in women? - CORRECT ANSWER Breast cancer • What is the number one cause of death in women? - CORRECT ANSWER Heart disease • A child presents with a hyperextended neck, excess drooling and appears to be in respiratory distress. Unable to perform ROM due to neck hyperextension. What type of condition are we concerned with? - CORRECT ANSWER Epiglottitis • What imaging should be ordered when concerned about epiglottis? - CORRECT ANSWER Lateral x-ray of neck • If you have a patient with croup and order a lateral CXR, what will the x-ray look like? - CORRECT ANSWER A steeple sign • If a parent brings their child in having an asthma exacerbation. Child appears fatigued, stridor, cyanotic membranes. Would you give a SABA stat, an albuterol treatment, epi injection, or inhaled corticorsteroid stat? - CORRECT ANSWER Give an epi injection, sign of respiratory arrest • What is the number one bacteria that causes community acquired pneumonia? - CORRECT ANSWER Strep pneumonie • What is the only known treatment to prolong life in a patient with COPD? - CORRECT ANSWER Supplemental oxygen If a patient presents with a diastolic murmur at the left sternal border and the murmur has an opening snap, what is it? - CORRECT ANSWER Mitral stenosis • A patient with CAD, HTN, and HLD. Taking atorvastatin 10mg initiated 4 weeks ago. Lipids still increased at follow up appointment. What is the next step in care? - CORRECT ANSWER Increase the atorvastatin to 20mg • What lab was checked in this patient prior to starting statin drug in this patient? - CORRECT ANSWER LFT • Pt complains of muscle weakness fatigue, and dark urine, what should be considered? - CORRECT ANSWER Rhabdomylosis; stop medication and hydrate with PO fluids or IV saline • A 40-year-old male who smokes 1 pack per day with achy legs, ruber, low back pain. What is the first test to confirm PAD? - CORRECT ANSWER ABI first • What is the definitive test to confirm PAD if ABI is less than 0.9? - CORRECT ANSWER arteriogram/angiography • A patient has edematous legs that are reddened, absent or faint pulses, and a history of diabetes. What should we be concerned for and how do we confirm diagnosis? - CORRECT ANSWER DVT and order ultrasound • LDL 130, taking atorvastatin 20mg, what is appropriate next step? - CORRECT ANSWER Increase statin • Total cholesterol 199 which is appropriate? Start on fenofibrate, start on atorvastatin, educate about lifestyle modifications and diet? - CORRECT ANSWER Educate about lifestyle changes!! • What blood pressure medication class needs to be weaned? - CORRECT ANSWER Beta blockers What food or drink can not be given with a statin? - CORRECT ANSWER Grapefruit or grapefruit juice Where would you hear the S3 sound on a patient? - CORRECT ANSWER Mitral area • What patient population is this found in? - CORRECT ANSWER heart failure and pregnant population • Where is the split S2 sound heard? - CORRECT ANSWER Pulmonic area, 2nd intercostal left sternal border • What patient population do you hear S4 sound in? - CORRECT ANSWER LVH • What syndrome would you hear the MVP click? - CORRECT ANSWER Marfans syndrome • What drug is associated with lipoprotein? - CORRECT ANSWER Thiazide diuretics (HCTZ) • What medication is a good choice to give a patient who has diabetes or renal disease? - CORRECT ANSWER ACE or ARB • If a patient is started on Lisinopril and later on we learn they have a dry hacking cough, what would be appropriate to give them next? - CORRECT ANSWER An ARB • What murmur is going to radiate to the axillae? - CORRECT ANSWER Mitral regurgitation; 5th intercostal space left sternal border holosystolic • What murmur is found at second intercostal space right sternal border and radiates to the neck? - CORRECT ANSWER Aortic stenosis • Why are we more concerned with diastolic murmurs than systolic murmurs? - CORRECT ANSWER They are pathologic in nature so they indicate heart disease • What grade of murmur would you hear a thrill for the first time? - CORRECT ANSWER Grade 4 • How would you describe murmur III/VI? - CORRECT ANSWER Moderate intensity • If a patient is taking Coumadin for afib, where do we want their INR? - CORRECT ANSWER 2.0-3.0 • If patient has prosthetic valve, what should their INR be? - CORRECT ANSWER 2.5-3.5 • A patient with a low HDL is at risk for what? - CORRECT ANSWER Heart disease, usually concern at less than 40 • What is a physiological change that can cause arrhythmias in the elderly? - CORRECT ANSWER Sinoatrial fibrosis • What are the side effects of thiazides? - CORRECT ANSWER Hypertriglycerides, hyperglycemia, and hyperuracemia, 3 out of 4 will cause metabolic syndrome and thiazides are contraindicated; hypertension, obesity, high lipids, or diabetes can lead to metabolic syndrome; pts with gout and kidney stones should not take either • What other diagnosis besides CHF is contraindicated for a calcium channel blocker? - CORRECT ANSWER GERD, vasodilator causes acid to come back into esophagus • What is the condition we treat with a calcium channel blocker when they have discolored hands? - CORRECT ANSWER Raynaud's phenomenon • What medication is prescribed for isolated systolic hypertension? - CORRECT ANSWER Calcium channel blocker • What medication do we give to a patient post MI to reduce cardiac load? - CORRECT ANSWER Beta blocker • Pt presents with SOB, chest pain, nausea, back pain what do you expect EKG to look like? - CORRECT ANSWER ST elevation • What does afib look like on a monitor? - CORRECT ANSWER Irregular with no p waves • What heart condition has a prolonged PR interval 0.20? - CORRECT ANSWER first degree heart block • If a patient has cold edematous legs with ulcers and they say they need to elevate them to feel better, what condition are we going to rule out? - CORRECT ANSWER PVD or chronic venous insufficiency; pt with PAD need to dangle their leg to feel better not elevate; educate about TED hose or compression socks to help with edema • If you have a pt that described splinter like hemorrhages on their fingernails, gradual onset of fever, Osler nodes what is differential diagnosis? - CORRECT ANSWER Bacterial endocarditis • If a patient has asthma and experiences a significant drop in BP with inspiration, what is that condition called? - CORRECT ANSWER Pulses paradoxes • If a 42-year-old male smokes a pack of day complains of a ripping sensation in his back. What are we ruling out and how do we test to confirm diagnosis? - CORRECT ANSWER AAA, abdominal ultrasound needs to be ordered • If a patient has a high triglyceride (1200) what are they at risk for developing and what should be prescribed? - CORRECT ANSWER Pancreatitis, niacin or fenofibrate to help lower triglycerides • What labs would be ordered when concerned about pancreatitis? - CORRECT ANSWER Lipase and amylase • What dietary education should be given to patient with prehypertension or hypertension? - CORRECT ANSWER Limit salt intake • Reasons for a person to develop tachycardia: - CORRECT ANSWER dehydration, hyperthyroid, acute blood loss, anemia, infection, drug overdose or toxicity • If someone comes in with a PE and has been sitting on a train for 5 hours, they need to be started on Coumadin and want INR between 2.0-3.0, what is the minimum duration after developing a PE to stay on Coumadin? - CORRECT ANSWER therapy in range for at least 6 months • What tests are ordered to check for stable angina? - CORRECT ANSWER Stress test • What grade of murmur is so loud you don't have to use a stethoscope to hear it? - CORRECT ANSWER Grade 6 • If you have an older man who is requesting Viagra, what needs to be done first before prescribing? - CORRECT ANSWER EKG • What single lab test does the NP check for both hyper and hypothyroid? - CORRECT ANSWER TSH • If you have to start someone on medication for hypothyroid, what dose do you start therapy with? - CORRECT ANSWER 25mcg • When is the soonest to recheck a TSH after initiating therapy? - CORRECT ANSWER 6-8 weeks • If we have a patient that is diagnosed hyperthyroid and is pregnant, what medication should be prescribed? - CORRECT ANSWER PTU • What are symptoms of hyperthyroidism? - CORRECT ANSWER Weight loss, goiter, tachycardia, exophthalmos • What is the gold standard for diagnosing Hashimotos? - CORRECT ANSWER TPO • If a patient is diagnosed with diabetes and prescribed metformin, what condition is important to monitor? - CORRECT ANSWER Lactic acidosis • Patient is a diabetic and says they have to get up at 3 am to get a snack because they feel their sugar dropping. What is this called? - CORRECT ANSWER Somogyi effect; decrease Lantus at bedtime and eat snack before bed • Where should A1C goal be for a type 2 diabetic? - CORRECT ANSWER 7.0 • Elderly should have an A1C of what? - CORRECT ANSWER 8.0 • Pregnant woman should have an A1C of what? - CORRECT ANSWER 6.0 If patient has hyperparathyroidism high calcium (12), what medication can be prescribed? - CORRECT ANSWER Biphosphates (removes calcium from blood and pulls it into the bones) • What substance is released by the pancreas to counteract hypoglycemia? - CORRECT ANSWER glucagon • Education to include what for prediabetics? - CORRECT ANSWER Exercise 5 days a week and limit carbs • 14-year-old male not comfortable in gym class with changing, what body image condition would make him uncomfortable at that age in gym class undressing? - CORRECT ANSWER Gynecomastia; education for parents should include condition will go away in 6 months-2 years on its own Pt craving salty foods, decreased cortisol, bronzed colored skin, decreased sodium and increased potassium. What is disease called? - CORRECT ANSWER Addison's Increased cortisol, increased sodium, decreased potassium, "moon face". What is this condition? - CORRECT ANSWER Cushing's syndrome What medication can cause gynecomastia? - CORRECT ANSWER Aldactone • Patient has micro aneurysms or cotton wool spots seen in eye (spider veins) what preexisting condition do you expect the patient to have? - CORRECT ANSWER Diabetes or diabetic retinopathy • An absent red reflex in a newborn, what could be the cause? - CORRECT ANSWER Cataracts • What condition will a NP assess for in the pt who has a fundoscopic exam that shows the copper wire arterioles that cross the hemorrhaging vein? - CORRECT ANSWER HTN (AV nicking) • What is another name for the mono spot test? - CORRECT ANSWER Heterophil • If a patient is describing sudden onset painful vision, seeing halos, cupping in the optic disc, what are we concerned about and plan of care? - CORRECT ANSWER Acute or closed angle glaucoma; cupping in optic disc is always glaucoma; medical emergency; open angle is gradual loss of peripheral vision • What is the first thing to do when a patient comes in with vision problems? - CORRECT ANSWER Visual acuity • If a patient has a swollen optic disc, blurred vision d/t increased ICP what is this called? - CORRECT ANSWER Papilledema; reasons include uncontrolled HTN, brain tumor, meningitis • A patient comes in with nighttime vision problems with absent red reflex on eye exam. What condition should be concerned? - CORRECT ANSWER Cataracts • This is a common cause of blindness and a loss of central vision? - CORRECT ANSWER Macular degeneration • If a patient complains of black curtains coming down over eyes, painless. What condition should be concerned? - CORRECT ANSWER Retinal detachment • What is the first line treatment for otitis media? - CORRECT ANSWER Amoxicillin • Kid comes in with otitis media and is prescribed antibiotics this visit after watch and wait. Took amoxicillin recently or didn't work. What would be prescribed next? - CORRECT ANSWER Augmentin • What is the bacteria that causes otitis media? - CORRECT ANSWER Strep pneumo • Otitis externa treatment? - CORRECT ANSWER Cipro drops • Organism responsible for causing otitis externa? - CORRECT ANSWER Pool, pond, pseudomonas • Weber test and have conductive hearing loss. Where will weber lateralize affected or unaffected ear? - CORRECT ANSWER Affected ear; cerumen impaction, foreign body, effusion, infection can cause conductive hearing loss; sensorineural hearing loss can be Meniere's disease WUS (weber unaffected ear sensorineural) WAC (weber affected ear conduction) • Conductive hearing loss and Rhine test. What will be seen? - CORRECT ANSWER Bone conduction greater than air conduction; normal is AC greater than BC • What symptoms might be seen during a Meniere's acute attack? - CORRECT ANSWER Nausea, vertigo, balance issues, tinnitus, bilateral nystagmus • Difference between bacterial and viral conjunctivitis concerning presentation? - CORRECT ANSWER Bacterial: purulent drainage usually unilateral, itchy, self limiting with eye drops. Viral: bilateral drainage, tearing, stringy discharge, allergy medication • If a child was diagnosed with mono, when can he go back to playing football? - CORRECT ANSWER 4-6 weeks, no splenomegaly, no longer palpable • Characteristic of mono: - CORRECT ANSWER sore throat, fever, cervical lymphadenopathy, rash, fatigue; limit contact sports due to enlarged spleen • What test can a provider use to check for benign positional vertigo? - CORRECT ANSWER Dix Hallpike test • If a patient has a pinpoint area on eyelid and lots of swelling around this. What condition could be present? - CORRECT ANSWER Orbital cellulitis; worry about pt going blind• • What is myopia? - CORRECT ANSWER Nearsightedness • If a patient is complaining about holding arms out in front and think arms look shorter look for what? - CORRECT ANSWER Myopia • If you've treated a child with an effusion with Augmentin and now mom calls to say bloody discharge is coming from ear. What do you tell them? - CORRECT ANSWER Probably have TM rupture and will heal on his own as long as child does not show hearing issues It should be fine • What is another name for chancre sore? - CORRECT ANSWER Apthous ulcer or stomatitis • If a newborn comes in with excessive tearing, frequent crusting, what is this condition called? - CORRECT ANSWER Dacrocystitis; treatment includes topical abx and warm compress and lacrimal massage • If you suspect obstructive sleep apnea in a patient, causes can include everything except? - CORRECT ANSWER Microglossia (absence of tongue) • A patient presents with a nosebleed. The NP knows teaching is ineffective when the pt says what? - CORRECT ANSWER I'm still using my nose spray daily • What condition puts a woman at increased risk for an ectopic pregnancy? - CORRECT ANSWER Salpingitis • What natural breast changes happen with aging in women? - CORRECT ANSWER Dense breast tissue will atrophy and replaced with fat.• • What age does ACOG suggest for women to start getting annual pap smears? - CORRECT ANSWER 21 • If a woman is complaining of post menopausal bleeding, what should be done first? - CORRECT ANSWER Endometrial biopsy • If you can palpate an ovary on a woman, what do you need to do? - CORRECT ANSWER Transvaginal ultrasound • What does the coombs test look for? - CORRECT ANSWER Detect the present of Rh antibodies; check for antibodies that can cause hemolytic anemia in the infant • Positive signs of pregnancy: - CORRECT ANSWER what the provider can see or hear; fetal heart tones and seeing the baby on an ultrasound • Presumptive signs of pregnancy: - CORRECT ANSWER what mom feels; nausea, vomiting, fatigue, breast tenderness • Probable signs of pregnancy: - CORRECT ANSWER Chadwick's sign and Hegar's sign • What is the education for activity in a patient with preeclampsia? - CORRECT ANSWER Lay on right side and bed rest • High risk for developing ovarian cancer would be someone with what? - CORRECT ANSWER family history of the disease • If a woman is pregnant and can palpate the fundus at symphysis pubis, how are along is the pregnancy? - CORRECT ANSWER 12 weeks; 16 weeks will be between symphysis pubis and umbilicus • Where would the fundus be palpable at 20 weeks? - CORRECT ANSWER At the umbilicus • If you have a woman who is pregnant and has an asymptomatic UTI. Do you treat this patient with antibiotics? - CORRECT ANSWER Yes; if not treated, at risk for fetal complications or premature labor • Appropriate treatment for a UTI in a pregnant woman? - CORRECT ANSWER Macrobid (not in third trimester), amoxicillin • No smoker should be on contraceptive medications because of what? - CORRECT ANSWER DVT, MI, CVA; Mycuplits • Contraindications for estrange replacement? - CORRECT ANSWER Estrogen fed cancers in women; breast, endometrial cancer • A woman over the age of 25 has LSIL changes on pap smear. What happens next? - CORRECT ANSWER Colposcopy • Same woman has HSIL changes on pap smear. What happens next? - CORRECT ANSWER LEEP • The woman who is producing milk but not pregnant. What is this condition and what lab is checked to confirm diagnosis? - CORRECT ANSWER Galactoria; prolactin level • If an older woman is complaining about dryness during intercourse and pain with intercourse. What can be prescribed? - CORRECT ANSWER Topical estrogen replacement • Natural estrogen replacements? - CORRECT ANSWER Black cohosh, soy bean, isoflavin • If a woman is breastfeeding and wants to take PO contraceptives what is best? - CORRECT ANSWER Progesterone only • When do we administer rhogam injection? - CORRECT ANSWER 28 weeks and 72 hours after birth; Rh negative mom with Rh positive baby • When do we check alpha-fetoprotein? - CORRECT ANSWER 16-20 weeks • What is the treatment for chlamydia? - CORRECT ANSWER Azithromycin 1-gram X 1 dose • What is the treatment for gonorrhea? - CORRECT ANSWER Rocephin and azithromycin (2 Rs treat with 2 things) • If a patient presents with a strawberry colored cervix with gray-green discharge. What should they be treated with? - CORRECT ANSWER Concerned for trichimoniasis; Flagyl • Squamous epithelial cells, milky discharge, and fishy vaginal odor (whiff test). What is this and the treatment? - CORRECT ANSWER BV; flagyl • What is the screening test for syphilis and what confirms syphilis? - CORRECT ANSWER RPR or BVRL; Stab's test • A baby was delivered forceps. What are we concerned about? - CORRECT ANSWER Cephlahematoma; the baby will have jaundice and REMEMBER jaundice is typically seen first in sclera • When do the baby's anterior and posterior fontanels close? - CORRECT ANSWER 15-18 months; 2-3 months • If a patient has a CD4 count less than 200 what do we tell them? - CORRECT ANSWER They now have AIDS; if they are currently on treatment meds they can stop because it isn't working What age can a child get an MMR/varicella vaccine? - CORRECT ANSWER Not given before 12 months of age • After what age can a child get the influenza vaccine? - CORRECT ANSWER 6 months • After what age can a child get the TDAP vaccine? - CORRECT ANSWER Over the age of 7 • If a baby has an umbilical hernia, what should we tell the parents as education? - CORRECT ANSWER The hernia will go away within 2 years; be concerned if its painful, appears to be tender, or discoloration appears • What is it called when the pregnant lady has skin changes to her face (hyperpgimented patches)? - CORRECT ANSWER Colasma or molasma • A baby's weight doubles at what age? - CORRECT ANSWER 6 months of age A baby's weight triples at what age? - CORRECT ANSWER 12 months of age • What is secondary amenorrhea and who is it seen in? - CORRECT ANSWER A girl has had her period and it stopped; seen in athletes or a girl that is pregnant What is primary amenorrhea? - CORRECT ANSWER absence of menstruation at all • If you see entowing in the newborn when do you refer to ortho? - CORRECT ANSWER Immediately • What do we tell the parents about a baby that has hydrocele and do we need to be concerned about it? - CORRECT ANSWER Should resolve by 12 months of age unless swollen or painful; surgical draining of fluid if needed • How do you treat bronchiolitis? - CORRECT ANSWER Does not require treatment; supportive care • What is a medication that is used for bipolar disorder that has a low therapeutic threshold? - CORRECT ANSWER Lithium; very easy to get lithium toxicity • What are the symptoms and patient presentation for lithium toxicity? - CORRECT ANSWER Everything will speed up; tachycardia, slurred speech, lethargic, decreased level of consciousness, GI upset; serotonin syndrome- fever muscle rigidity • Type of growth plate fracture that involves the epiphyseal plate? - CORRECT ANSWER Salter Harris fracture • What test is used in orthopedics if checking for anterior shoulder instability? - CORRECT ANSWER Apprehension test • Adverse effects of too much vitamin D? - CORRECT ANSWER fatigue, weight loss, excessive thirst, constipation, and pancreatitis • What are natural herbs that can cause bleeding? - CORRECT ANSWER St john's wart, garlic, ginger, gingobaloba • What is the maneuver used to check for carpal tunnel? - CORRECT ANSWER Balance test or maneuver • If someone has recurrent herpes outbreaks, what could be symptoms besides the sores? - CORRECT ANSWER Tingling or itching at the site prior to an outbreak • What lab would you check for lupus? - CORRECT ANSWER ANA • What is the test to check for functional mobility if looking for risk of falls in the elderly? - CORRECT ANSWER Timed get up and go test; 14 seconds puts them at risk for falls • If a provider can palpate a nodule over the flank of a baby and it does not cross the midline, what are we concerned about? - CORRECT ANSWER Wilm's tumor/nephroblastoma • 13-year-old soccer [player complains of knee pain, what should we rule out? - CORRECT ANSWER Osgood Schlatter disease; at tibial tuberosity • If someone has avascular necrosis of the femoral head, what is this? - CORRECT ANSWER Leg calfe pertheis • Syndrome found in boys with an extra x chromosome, wider hips, and risk for infertility? - CORRECT ANSWER Klein Felter syndrome • Syndrome in girls worried about ovarian failure or infertility, short neck? - CORRECT ANSWER Turner's syndrome • The test where you are asking the elderly patient to repeat three words back to you is called what? - CORRECT ANSWER Mini mental status exam • Alzheimer's disease is a loss of what function? - CORRECT ANSWER Executive function • If a patient has a blank state several times a day, we need to worry about what? - CORRECT ANSWER Petite mal or absence seizures • Cranial nerve responsible for bells palsy? - CORRECT ANSWER 7 (facial) • Cranial nerve responsible for trigeminal area? - CORRECT ANSWER 5 • Cranial nerve responsible for extraoccular movements? - CORRECT ANSWER 3, 4, 6 make your eyes do tricks • If we are assessing Weber and Rhine, which cranial nerve are we looking at? - CORRECT ANSWER 8 • What is the treatment for trigeminal neuralgia? - CORRECT ANSWER Anticonvulsants, tegretol • How to treat polymyalgia rheumatica? - CORRECT ANSWER Long duration of steroids with extremely slow titration usually over a 12-month period • What does a patient have to have to diagnose fibromyalgia? - CORRECT ANSWER 11 out of 18 trigger points for greater than a 3-month period and the pain has to be bilateral • If you have a patient that comes in with burns, what do you use to calculate the percentage of burns? - CORRECT ANSWER Rule of nines • This is a memory disorder often seen in alcoholics, usually caused by a thymine deficiency? - CORRECT ANSWER Korsakoff syndrome • What would be the cause of frequent nosebleeds in adolescents? - CORRECT ANSWER Drug usage specifically cocaine • What test is used to check for premature rupture of membranes (PROM)? - CORRECT ANSWER Pelvic exam and ferning test to check for amniotic fluids • If a patient comes in complaining of soreness in mouth with eating. Painful lump noted on jaw that comes and goes. What are we worried about? - CORRECT ANSWER A salivary calculi or stone • What is treatment for this condition? - CORRECT ANSWER Mild case can hydrate and NSAIDs, sometimes antibiotics, sometimes massaged out by provider. If bad, will need to be referred to ENT for surgery • If an infant is born with clubfoot, when do you refer and who do you refer to? - CORRECT ANSWER Refer to ortho ASAP • What age can a baby roll both ways? - CORRECT ANSWER 6 months • When does a baby regain its birth weight? - CORRECT ANSWER 2 weeks • What is it called when you have heel pain that starts in the morning and gets worse during the day? - CORRECT ANSWER Plantar fasciitis • What is the treatment for plantar fasciitis? - CORRECT ANSWER Stretching exercises, ice, NSAIDs, orthotics if needed • What is in the ear that appears to be a cauliflower like object that has an odor. What is it called and what do we do? - CORRECT ANSWER Cholesteatoma, refer to ENT for possible surgery • What is the rash that shows up after the virus? What virus is this? - CORRECT ANSWER Roseola • If someone comes in with white papules on the gums that resemble teeth. What is this called? - CORRECT ANSWER Epstein's pearls • Which is the least likely sign of child abuse? - CORRECT ANSWER Bruises on the shin • What is the urethral opening on top or on the upper aspect of the glans penis called? - CORRECT ANSWER Epispadias • What is the opening on the bottom of the glans penis called? - CORRECT ANSWER hypospadias • At what Tanner stage would a female develop breast buds? - CORRECT ANSWER Tanner stage 2 • When would we expect them to hit menarche after Tanner stage 2? - CORRECT ANSWER 1-2 years • What Tanner stage does the female develop a secondary mound in both breasts? - CORRECT ANSWER Tanner stage 4 • What Tanner stage do males have scrotal rugae and the testes enlarge? - CORRECT ANSWER Tanner stage 2 • What Tanner stage does the penis widen in males? - CORRECT ANSWER Tanner stage 4 • This is a condition due to compression of the spinal cord there could be acute onset o f bowel and bladder incontinence and numbness of bilateral legs. What is this condition? - CORRECT ANSWER Cauda equina syndrome • What is treatment in cauda equine syndrome? - CORRECT ANSWER They need to go to the ER for decompression • If you have an elderly patient that comes in with Parkinson's like symptoms, what type of dementia could this be? - CORRECT ANSWER Lewy bodies dementia • If an infant comes in with entowing, what should you do? - CORRECT ANSWER We typically reassess at the next visit; after a year with no resolution, refer out • If the female patient presents with galactoria and missed her period for more than 3 months, what would you do? - CORRECT ANSWER Urine pregnancy test; if negative, check prolactin level • If you have a patient who suffers from BPH and HTN, what medication would be good for them? - CORRECT ANSWER Hytrine or an alpha blocker • If you have an older woman suffering from new onset urinary incontinence, what are we going to do first? - CORRECT ANSWER Order a UA • What is the main lab that we look for if we are assessing renal function? - CORRECT ANSWER GFR • If a patient has pyelonephritis, what would you expect to see in the urine? - CORRECT ANSWER Hematuria, WBC casts or WBC 10 • If a patient has 3+ protein in urine, what is the next test to do? - CORRECT ANSWER 24-hour urine to check for albumin and creatinine • What is the number one reason that men stop taking their SSRI? - CORRECT ANSWER Erectile dysfunction • Why do we have to be careful doing a prostate exam and worried about prostatitis? What is the patient at risk for? - CORRECT ANSWER We do not want to introduce septicemia or bacteremia; do not massage the prostate • If a patient falls on their wrist and complaining about wrist hurting. X-ray shows nothing but patient is still complaining two weeks later. What injury are we looing for? - CORRECT ANSWER Snuff box, scaphoid fracture, thumb splint • Woman complains of pain between her third and fourth metatarsal, wears heels often. What is this condition? - CORRECT ANSWER Morton's neuroma, squeeze or moulder's test to confirm • If a child comes in limping after fall a couple of weeks ago. The limp and knee pain are worsening. What condition might this be? - CORRECT ANSWER Slipped capital femoral epiphysis • How do we treat stress fracture? - CORRECT ANSWER Shin splint, RICE • What test can be used to check the ACL? - CORRECT ANSWER Lochmans and anterior drawer test • What test can be used to check MCL? - CORRECT ANSWER McMurray's test • If you have a patient who has gout, what medication is going to reduce the uric acid levels? - CORRECT ANSWER Allopurinol prophylactic treatment, colchicine for acute flare-ups • If you have a patient with osteoarthritis, what type of exercise should they do? - CORRECT ANSWER Nonweight bearing • How do you treat plantar fasciitis? - CORRECT ANSWER RICE, orthotics, NSAIDs nonelderly, night splints To assess the MCL, what stress is applied? - CORRECT ANSWER Valgus stress (knock knees) What stress is applied for the ACL? - CORRECT ANSWER Varus stress (frog leg) • What activity relieves herniated disc pain? - CORRECT ANSWER Walk or stand • What activity relieves lumbar stenosis? - CORRECT ANSWER Sitting (LUM YOU'RE A BUM) • If a weight lifter comes in complaining of a painful bulge in his upper arm. What are we worried about? - CORRECT ANSWER Bicep tendon rupture; hook test • How many grades of sprains are there? - CORRECT ANSWER 3 • Grade 2 sprain you can still? - CORRECT ANSWER bear weight but use crutches or assistive device • Grade 3 sprain you need a? - CORRECT ANSWER wheelchair and nonweight bearing • This is a condition seen in a gymnast complaining of decreased ROM in her ankle, due to lack of blood flow. What condition is this? - CORRECT ANSWER Osteochondrytis dissacans • Gold standard for diagnosing a soft tissue injury? - CORRECT ANSWER MRI • What is another name for lateral epicondylitis? - CORRECT ANSWER Tennis elbow; treat with elbow or wrist immobilizer • Who has the highest successful suicide rate? - CORRECT ANSWER Middle aged men • If a patient comes in with bipolar disorder, what symptoms might you see in their demeanor? - CORRECT ANSWER Flight of ideas, grandiosity • **If an elderly patient has new rapid onset of confusion, what labs should we check for reversible causes? - CORRECT ANSWER UA, TSH, CBC, BMP • What is the main medication that causes acute rapid onset of confusion in the elderly? - CORRECT ANSWER Benadryl • What do we need to monitor in patients on atypical antipsychotics? - CORRECT ANSWER A1c and BMI • What is a natural herb for anxiety? - CORRECT ANSWER Caba-caba • If a patient has a positive obturator, psoas and rovsing sign, what condition do they have? - CORRECT ANSWER Appendicitis • If a patient has a positive gray turner's sign, what does this indicate? - CORRECT ANSWER Pancreatitis • If a patient complains of right upper quadrant and Murphy's sign, what condition are we worried about? - CORRECT ANSWER Cholecystitis • Patient complains of right upper quadrant pain, anorexia, fatigue and jaundice. What are we worried about? - CORRECT ANSWER Hepatitis • What time of day should you educate your patient to take an H2 blocker? - CORRECT ANSWER H2 at HS • If a bay comes in with current jelly like stools, what condition is this? - CORRECT ANSWER Intussception • If the baby has projective vomiting and after vomit we can palpate an olive shaped mass? - CORRECT ANSWER Pyloric stenosis • First line treatment for Zollinger's disease? - CORRECT ANSWER PPI • Patient complains about a pencil like stool. This is concerning for what? - CORRECT ANSWER Descending colon cancer • If a patient has chronic hepatitis C, which will be high AST, ALT, or both? - CORRECT ANSWER ALT • A man in ER with abdominal pain and was sent home. Comes back in office 4 days later with high lipase level and worsening abdominal pain. He needs to be admitted to the hospital for what? - CORRECT ANSWER Pancreatitis • How does the NP check the infant for dehydration? - CORRECT ANSWER Fontanels; depression in fontanels • A very weak newborn baby that is sleeping a lot and not feeding well. What do we need to do? - CORRECT ANSWER Take a full history, worried about congenital heart defect • What is the most common cause of death in adolescents? - CORRECT ANSWER Motor vehicle accidents • If mom is pregnant and has never gotten MMR vaccine. When does she need to get it? - CORRECT ANSWER After birth • If mom and dad are both heterogeneous for carrying a trait, what is the chance that a baby will also carry it? - CORRECT ANSWER 25% • Characteristics of fetal alcohol syndrome include what? - CORRECT ANSWER Infant who is irritable, crying nonstop, inconsolable, small birth weight, microcephaly • If the baby has a UTI, what tests are we going to order next? - CORRECT ANSWER Ultrasound • If a patient has a red beefy tongue, what type of anemia are we worried about? - CORRECT ANSWER B12 • A chronic alcoholic will have what type of anemia? - CORRECT ANSWER Folate deficiency • What is the screening tool for anemia? - CORRECT ANSWER H&H • What is your education for a patient with sickle cell anemia? - CORRECT ANSWER Stay hydrated and get all recommended immunizations • What is the gold standard for diagnosing sickle cell? - CORRECT ANSWER Hemoglobin electrophoresis • Patient with pale skin, spoon shaped nails, and craves ice. What kind of anemia is this? - CORRECT ANSWER Iron • Macrocytic anemia: - CORRECT ANSWER b12 and folate, increased MCV • Microcytic: - CORRECT ANSWER iron and thalassemia, decreased MCV • What anemia is going to cause numbness and tingling to hands and feet with weakness and neuro like symptoms? - CORRECT ANSWER B12 • If woman comes in with Paget's disease in the breasts. What do we need to do? - CORRECT ANSWER Mammogram • If you're treating an elderly patient for arthritis and OTC Tylenol is helping with pain. Labs are checked and sed rate is slightly elevated. Do we switch to NSAID or keep taking Tylenol? - CORRECT ANSWER Leave them on Tylenol; avoid NSAID in elderly • If you have a patient that has HTN and you need to prescribe a HTN medication. Pt has a history of pedal edema 1+ bilateral lower extremities. What is a side effect to remember for amlodipine? - CORRECT ANSWER Medication can cause pedal edema • A patient comes in and is describing having waxy, waning nasal congestion, headache when bending over X 2 weeks. Symptoms not improving. Upper teeth pain as well. What should be included in differentials? - CORRECT ANSWER Maxillary sinusitis (can cause dental pain) • A patient on day 3 of eye discomfort and end up being diagnosed with mild blepharitis without corneal abrasion. What would be appropriate treatment at this time? - CORRECT ANSWER Treatment will be wash lid margins with baby shampoo; antibiotics, drops, or cream are not appropriate • Adolescent patient with long term use of steroids. Patient at an increased risk for developing what? - CORRECT ANSWER Musculoskeletal problems (can cause growth retardation, increased fractures, osteoporosis) • What is the most cost effective treatment for an acute shingles outbreak? - CORRECT ANSWER Acyclovir • A patient has been acutely ill for a couple of days, starting to develop a high fever, headache, and positive Curnig's sign. What are you concerned about? - CORRECT ANSWER Meningitis • Which of the following is not risk factor for thrombosis? - CORRECT ANSWER Weight gain • If you have a type 1 diabetic, you know that the patient is following the treatment plan when the A1c is less than what number? - CORRECT ANSWER 6.5% • What is the reason that the elderly patient has an increase in fat causing them to need less carbs but more intense nutrients? - CORRECT ANSWER They have a decrease of lean body mass • A 19-year-old girl discloses that she does struggle with drugs and last week she shared a needle. She states she's not going to do it again and she's done with drugs. What test do you need to order? - CORRECT ANSWER Hepatitis and HIV panel looking for hepatitis C • A 5-year-old male with right sided flank mass. Also has trace blood in urine. What should be included in differential? - CORRECT ANSWER Wilm's tumor • Frail elderly patient has a UA with multiple organisms present. The patient is asymptomatic. What are you going to do? - CORRECT ANSWER Treat with levaquin • An entire family comes in with elderly mom for a check up. Mom has been confused starting this morning with left sided weakness and poor balance. What are you going to do? - CORRECT ANSWER Call 911 and go to emergency room • Which of the following would you expect to be present if worried about an injury in the Brokus area? - CORRECT ANSWER Aphasia (Brokus area is associated with language) • An infant's mother comes in for regular check up. She tells you that she went ahead and changed his milk to goat milk. This infant has signs and symptoms of anemia. Which test are you going to run first? - CORRECT ANSWER CBC (always looking for H&H first) • A common cause of ankle sprain is inversion spring. If the patient comes in with an eversion sprain, what do you need to do? - CORRECT ANSWER Referral to podiatry or ortho; concerned about inner ligament stretched or torn • If you have a patient that you did a vaginal exam on. There is a clue cell present. BV suspected and flagyl given but not working. What could you do next? - CORRECT ANSWER Clindamycin cream • If you have a newborn infant that was born with an absent red reflex. What is that? - CORRECT ANSWER Congenital cataract • All of the following are a cause of physiological hyperbilirubin except? - CORRECT ANSWER Exclusive feeding • An elderly patient has a positive occult test with known anemia. Reports diarrhea and constipation both at times. What needs to be ordered next? - CORRECT ANSWER Refer for a colonoscopy • The skin condition that Is considered a precursor to squamous cell cancer, not considered benign? - CORRECT ANSWER Actinic keratosis • A child comes in with eczema presents as small vesicles that rupture, weepy, and red lesions. What else should the NP assess for in this child? - CORRECT ANSWER Asthma and allergies • What is the treatment for someone with these lesions? - CORRECT ANSWER For a mild case use topical, such as lotions or emollients. If severe, topical steroids added; if question says recurrent go to second line treatment and assume severe • What is the most common type of skin cancer? - CORRECT ANSWER Basal cell carcinoma • What is the most deadly type of skin cancer? - CORRECT ANSWER Melanoma • What is the acronym and what does it stand for in melanoma? - CORRECT ANSWER ABCDE; asymmetry, border, color, diameter, elevation • What are we going to do if were concerned for melanoma? - CORRECT ANSWER Refer to dermatology • A child comes in with prominent bright red rash on cheeks, fever runny nose. What are we concerned with? - CORRECT ANSWER Fifth disease (slap cheek), caused by parovirus B19 Toddler comes in with fifth disease and mom is expecting a baby. What are we concerned about and what should education be? - CORRECT ANSWER Fetal demise, mom does not need to be caring for this child during the illness What condition does coxsackievirus cause? - CORRECT ANSWER Hand foot and mouth • A patient comes in with chronic and relapsing redness over chin and cheeks, no pustules. What condition does this patient have? - CORRECT ANSWER Rosacea • What can be prescribed to a patient with rosacea? - CORRECT ANSWER Metro gel • Redness over chin and cheeks with pustules? - CORRECT ANSWER Acne rosacea • What is the treatment for acne rosacea? - CORRECT ANSWER Metro gel and low dose tetracycline • What is first line treatment for a mild case of acne? - CORRECT ANSWER Topicals, benzo washes • What is treatment for moderate case of acne? - CORRECT ANSWER Tetracycline • What is treatment for a severe case of acne? - CORRECT ANSWER Refer to derm and Accutane • Patient states after starting face wash and creams for mild acne, pt calls stating face is red, angry and irritated. What is education for this patient? - CORRECT ANSWER Reduce the frequency of using the products but do not stop using them • A woman comes in with bumps on back of arm with white lines going through it. Doesn't cause pain, slightly itchy. What are we concerned with? - CORRECT ANSWER Lichen planus • If a baby comes in with white spots in mouth, cough and congestion. What might this child have? - CORRECT ANSWER Measles (rubeola) • Condition where the lesion is pearly and dome shaped, appears to have white plug, highly contagious. What is this? - CORRECT ANSWER Molluscum • If molluscum is found in the genital areas what are we concerned about? - CORRECT ANSWER Sexual abuse • What is the rash that is typically found on elbows or knees, silvery scales or fine scales, itchy? What is condition called? - CORRECT ANSWER Psoriasis • What is treatment for psoriasis? - CORRECT ANSWER Methotrexate • If talking about psoriasis about has pinpoint bleeding on scales, what is that called? - CORRECT ANSWER Auspitz sign • If a patient has psoriasis on elbows and they scrape their elbow on something and plaque spots fall off. What is it called when new plaque spots form over it? - CORRECT ANSWER Koebner phenomenon • If patient comes in with pruritic rash that itches more at night in webs of fingers, groin area. The lesions have a track. What are we concerned with? - CORRECT ANSWER Scabies; treat with premetherin cream • What should be included in education for this patient about disease and treatment? - CORRECT ANSWER Wash everything clothing, bedding in hot water • If you have a child that comes in with high fever, edema to hands or soles of feet, enlarged lymph nodes and present with strawberry tongue. What are we concerned about? - CORRECT ANSWER Kawasaki disease; may see question about cardiac or heart issues; leading cause of heart disease in children; treatment is aspirin and immunoglobulin • If we see a vesicular macular papular rash on trunk and spreads to face and extremities. Common in children. What is this virus? - CORRECT ANSWER Varicella • What is the treatment for varicella? - CORRECT ANSWER Symptomatic treatment, supportive measures; oral acyclovir in early severe cases; oral acyclovir is the cheapest of them all • When can children with varicella go back to school or are not contagious anymore? - CORRECT ANSWER Lesions have crusted over • If you have a newborn baby that comes in 2-3 days old, little fine white pimples on nose and cheeks. What is this condition and what do we tell the parents? - CORRECT ANSWER Millia and condition is normal and will resolve on its own • Child was playing and got bit by cat or dog. No symptoms at this time. What are we going to prescribe for this? - CORRECT ANSWER Augmentin • This skin condition involves superficial honey crusted lesions. What is this condition? - CORRECT ANSWER Impetigo • What is the treatment for impetigo? - CORRECT ANSWER Muprocion cream • This lesion is pearly and waxy, ulcerated center. What are we concerned about? - CORRECT ANSWER Basal cell carcinoma • A patient comes in with external genital warts. What are we going to treat with? - CORRECT ANSWER TCA (trichloric acid) • If patient is pregnant and has external genital warts. What is treatment? - CORRECT ANSWER Still treat with TCA All of these disorders can cause problems for an elderly patient except? - CORRECT ANSWER Seborrheic keratosis • What is the treatment for shingles? - CORRECT ANSWER Acyclovir • Skin lesion that has been present for a while. The patient is unsure if it is changing or not. What is the gold standard for diagnosing skin lesions? - CORRECT ANSWER Punch biopsy • This is a hyperpigmented area or patch on a child on upper neck, back or skin folds, could be velvety. What is this called? - CORRECT ANSWER Acanthosis nigricans • What lab should be checked if you see this in a child? - CORRECT ANSWER A1C • What is the rash that causes a sand paper type of red rash that runs to neck or trunk? - CORRECT ANSWER Scarlet rash • What are we going to treat group A strep with? - CORRECT ANSWER PCN or macrolide • If you have a diabetic that is walking barefoot, what condition can they develop? - CORRECT ANSWER Developing cellulitis and possibly osteomyelitis • What rash looks like a Christmas tree on the back or back of neck, sometimes described as Harold patch? - CORRECT ANSWER Pityriasis rosea • What is the treatment for pityriasis rosea? - CORRECT ANSWER no treatment it will go away on its own • If you have a mother that is breastfeeding and develops mastitis, what are we going to treat with and educate her on? - CORRECT ANSWER Keep breastfeeding and PCN or Keflex treatment • This is a condition that involves the dermis, usually poorly demarked and found in lower extremities, warm to touch, could be weeping and red. What is this condition called? - CORRECT ANSWER Cellulitis • This condition presents much like cellulitis but patient presents with a weak or absent pulse in the lower extremities. What would we be concerned about? - CORRECT ANSWER DVT • If somebody comes in with a spider and bite or thinks they got bit by something. If the area has started to spread a little bit, what can we do prior to their arrival in the clinic? - CORRECT ANSWER Put ice on it • What is the reason for putting ice on it? - CORRECT ANSWER Ice will help the toxins from spreading • If we have wart like lesions on fingers, typically caused by HSV 1 or 2 virus. What is this condition called? - CORRECT ANSWER Herpetic whitlow • This lesion is sometimes described as rough, dry, sometimes scabs, ulcerated center and bleeds easily, sometimes looks like crater. What is this called? - CORRECT ANSWER Squamous cell • How are we going to diagnose squamous cell? - CORRECT ANSWER Punch biopsy • Round, soft appearing wart seen typically on top of wart or head. Seen in sun exposed areas, benign. What is this called? - CORRECT ANSWER Seborrheic keratosis • What is the rash that shows up after the virus usually and in what condition? - CORRECT ANSWER Roseola • What rash does a fine lacey rash typically present with? - CORRECT ANSWER Fifth disease (parovirus B19) • What is the treatment for any MRSA lesion? - CORRECT ANSWER BCD (Bactrim, clindamycin, doxycycline) • If patient has a sulfa allergy and an MRSA lesion, which medication would we not prescribe from the three above? - CORRECT ANSWER Do not prescribe Bactrim • Red rash bilateral wrist or ankles, could develop chills, fever, nausea photophobia, pt recently went hiking. What are we worried about? - CORRECT ANSWER Rocky mountain spotted fever; treatment within 8 days or could be fatal; treat with doxycycline • What causes Rocky Mountain spotted fever? - CORRECT ANSWER Tick bites • What lab can we draw to confirm a diagnosis of this disease? - CORRECT ANSWER PCR; Treat before test comes back or patient could die • A ring like itchy rash with central clearing, could be seen in wrestlers. What is this condition? - CORRECT ANSWER Tinea corporis (Ring worm) • What is the treatment for tinea corporis? - CORRECT ANSWER Antifungals (-azole) • Red rash that presents on the chin, cheeks, and face, edematous, painful, involves dermis and layer of tissue underneath. What is this condition called? - CORRECT ANSWER Erysipelas • What is the treatment for erysipelas? - CORRECT ANSWER Treat with PCN • Skin cancer with highest mortality rate? - CORRECT ANSWER Melanoma • Target bulls eye rash caused from deer tick with central clearing, flu like symptoms. What is this called? - CORRECT ANSWER Lyme disease or erythema migrans • What is the treatment for Lyme disease? - CORRECT ANSWER Doxycycline • What is the treatment for erythema migrans in a 6-year-old child? - CORRECT ANSWER Amoxicillin; Child younger than 7 can not take doxycycline due to staining of teeth • What can we do to diagnose erythema migrans? - CORRECT ANSWER Western blot test or Elisa test • This is a skin condition that can develop as a result of inflammation in the sweat glands, typically in the axilla, nodules or pustules pea to marble size, very painful, can leave scars and tracks. What is this condition? - CORRECT ANSWER Hidradenitis suppurativa • What are we going to treat this with? - CORRECT ANSWER Augmentin or digloxicine • If you have fever and fatigue with weakness maybe paralysis or vision loss in late stages. An RNA stranded virus caused by a mosquito. What are we concerned with? - CORRECT ANSWER West Nile virus • Pre and post bronchial dilator medication, what are you assessing for? - CORRECT ANSWER Wheezing • Increased fremitus over posterior right middle lobe, what are we concerned about? - CORRECT ANSWER Bacterial pneumonia • On an x-ray where do you commonly see bacterial pneumonia? - CORRECT ANSWER Right middle lobe • What are we worried about if we have a child who has asthma and has been chronically using a high dose inhaled corticosteroid? - CORRECT ANSWER Stunted growth or mild growth retardation or immune system suppression • What is the first line treatment for community acquired pneumonia? - CORRECT ANSWER Macrolide (erythromycin or azithromycin) for uncomplicated first line treatment or mild cases • If you have an elderly patient with comorbidities they will get sicker faster and macrolides will not be first line. What would the treatment be for this patient? - CORRECT ANSWER Levaquin (respiratory fluoriquinolones) complicated, severe cases • What is the drug education needed for patients taking Levaquin? - CORRECT ANSWER If they develop any tendon pain or Achilles pain to stop medication and call provider CURB 65 determines if the patient can be managed outpatient or inpatient for their pneumonia. What criteria are included in CURB? - CORRECT ANSWER Confusion, urea greater than 19, respiration, and blood pressure and age 65 or older **HR not included in CURB 65!!